Health experts urge Americans to hold the salt

NUTRITION

Published 4:00 am, Monday, February 15, 2010

Before surging obesity rates made villains of trans fats and sugars, salt was the big nutritional bad guy in the American diet, linked to hypertension, heart disease and stroke.

Then waistlines expanded and expanded some more, and the focus shifted.

Now, aware that Americans' salt consumption has risen by 50 percent over the past 40 years largely because of an increased reliance on a diet of processed and restaurant foods, public health experts and politicians are attempting to put the spotlight back on salt and its harmful health effects.

Last month, New York City Mayor Michael Bloomberg asked restaurants and foodmakers to consider voluntarily reducing the salt content in their foods by 25 percent over five years. A few days later, San Francisco Mayor Gavin Newsom, who suggested last fall that the city find a way to scale back sugar consumption, said he was looking into Bloomberg's proposal, too.

Meanwhile, a UCSF doctor released a study suggesting that regulating the salt content in foods could save up to $24 billion a year in health care costs.

"Salt was one of those things we put on the back burner and ignored for a while," she said. "But we're recognizing that reducing salt by even a small amount will have a widespread beneficial effect."

Good and bad of salt

Salt is a dietary mineral made up mostly of sodium, which the body needs in small amounts. It maintains the proper balance of fluids in the body, for one thing. But it's easy to get too much sodium, especially for people who already have high blood pressure.

Black people and people older than 50 tend to be particularly sensitive to too much sodium. Public health experts say 50 to 70 percent of Americans should be controlling their sodium intake and keeping it below 2,300 milligrams, or about a teaspoon of salt, a day.

Doctors have known about the relationship between sodium and high blood pressure for more than 100 years, which is why salt was one of the first major targets in campaigns to prevent heart disease. But more recent research has shown that other factors - especially obesity - play a larger role in causing high blood pressure and, in turn, heart disease and stroke.

Losing 20 pounds, for example, can lower systolic blood pressure by 15 to 20 points, research has shown. Americans consume an average of about 3,400 milligrams - or roughly a teaspoon and a half - of salt a day, but cutting sodium to the recommended maximum of 2,300 milligrams can shave two to eight points off the systolic blood pressure.

"In the hierarchy of nutrition and risky foods, there are others ahead of salt," Hernandez said.

Ironically, Hernandez pointed out, the relatively recent focus on weight loss has probably contributed to people increasing the amount of salt they eat, especially in the form of premade meals designed to be low-fat and low-calorie. When food manufacturers take out the fat, they often add salt to make them taste better.

That leads to the main problem when it comes to reducing sodium: Americans don't have a lot of control over how much salt they eat. As much as 80 percent of the salt in a typical American diet comes from processed or restaurant foods; only about 10 percent of salt intake comes from food people prepare and season themselves, and the remaining 10 percent comes from the sodium found naturally in foods.

Cooking at home helps

Simply cooking more often at home would help most people reduce their salt intake, said Dr. T. James Lawrence, a hypertension expert at Kaiser Permanente in San Francisco. But sodium is prevalent in food products most people would never think of - cereal and bread, for example. And two products that look and taste very similar can have very different sodium levels.

It's impractical to ask most people to keep count of their sodium intake throughout the day, Lawrence said. It's almost impossible to get the sodium level of prepared restaurant foods. He tends to tell patients to read labels when they shop and compare the sodium content of similar foods, just to make sure they're buying the product with the lowest level.

It won't take long for most people to adjust to diets of lower salt.

"Many people are used to a high-sodium diet, so things lower in sodium taste a little bland to them at first," Lawrence said. "But our taste buds get used to the change over a period of a few weeks. If you have a potato chip covered in salt, and then you reduce the salt by one-third, it's still pretty salty."

Tips for cutting sodium in diet

Taste first: Limit the amount of salt you use at home. Taste foods before adding salt at the table.

Cook from scratch: Prepare more of what you eat in your own kitchen. Processed and premade foods, such as restaurant meals, are usually much higher in salt than what people make themselves.

Watch the snacking: Avoid salty snacks and fast food meals, which are especially high in sodium.

Read labels: Often, products that look exactly the same - cereals or tomato sauces, for example - will have very different sodium levels. A "low-salt" option doesn't always have the least sodium.

Start with a salad: When eating in a restaurant, order a salad first to fill up on low-sodium vegetables. Avoid soups, which are often heavy in salt.

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